Member Application

Welcome and thank you for your interest in the Lafayette Chamber. The Lafayette Chamber is an organization dedicated to providing our members with the resources to successfully compete in today’s marketplace.

Business Information

Company Name:
*

Phone:
*

Website:

Email:
*

Business Description (300 char max):
*

Directory Category:
*

Employees:

Full-timePart-time

Business Keywords (enter a space between words):

Comments / Questions:

Physical Address

Line 1:
*

Line 2:

City:
*

State:
*

Postal Code:
*

Country:
*

Mailing Address

Same as physical address

Line 1:

Line 2:

City:

State:

Postal Code:

Country:

Primary Contact Information

First Name:
*

Last Name:
*

Phone:
*

Fax:

Email:
*

Contact Preference:

EmailPhone

Login:
*

Password:
*

Social Networking:

LinkedInFacebookTwitter

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Billing Contact Information

Same as Primary Contact

First Name:

Last Name:

Phone:

Fax:

Email:

Contact Preference:

EmailPhone

Login:

Password:

Social Networking:

LinkedInFacebookTwitter

Address

Same as Member Address

Line 1:

Line 2

City:

State:

Postal Code:

Country:

Membership Options

Membership Package:
*

0-2 Employees:
$250.00 3-5 Employees:
$265.00 6-10 Employees:
$285.00 11-20 Employees:
$315.00 21-30 Employees:
$355.00 31-40 Employees:
$405.00 41-50 Employees:
$465.00 51-75 Employees:
$535.00 76-100 Employees:
$585.00 Over 100:
Call for quoteNon Business/Retired:
$125.00 Refers to non-business owner or retired personAssociate:
$125.00 Associate member is employed or associated with a company who has a full membership in the Chamber. Example: Real Estate Agent whose broker company is a member.Non-Profit/Religious/Fraternal Service Clubs:
$150.00 Banks/Savings & Loans/Credit Unions:
Call for quoteSecond Membership:
A Second Membership of same business owner is 1/2 the price of full membership. Call for quote.

Additional Opportunities:

We will contact you with additional information.

Enhanced Listing: $60.00Additional website exposure! Get your business noticed!Punch Card: $0.00Purchase 6 visits for the price of 5!Chamber Name Badge: $10.00Have a permanent name badge waiting for you at each event.Sponsorship: $0.00Take advantage of event sponsorships and advertising opportunities.Newsletter Inserts/Banner Ads: $0.00Marketing opportunities availableChamber Bucks: $0.00Get more business to your door by accepting chamber bucks!